Detail-oriented Claims Specialist driven to resolve claims fairly. Conducts thorough and informed investigations, precisely evaluates losses and negotiates settlements that satisfy the terms of the policy.
Builds and maintains professional and productive relationships and works to understand potentially conflicting points of view.
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Claims Specialist - State Farm Property Field
Pilot Catastrophe Services
Mobile, AL
09.2016 - Current
Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
Processed payments for valid claims according to established procedures.
Facilitated communication between claimants, providers, attorneys, adjusters, employers, and other parties involved in a claim.
Provided customer service by responding promptly to inquiries from claimants regarding their benefits or coverage.
Participated in continuing education seminars related to industry standards for insurance claims processing.
Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
Determined covered insurance losses by studying provisions of policies or certificates.
Business Owner/Operator
TD Services
Kyle , TX
12.2008 - 09.2016
Developed and implemented business strategies to increase profitability and market share.
Supervised staff, managed payroll and ensured compliance with labor regulations.
Reviewed customer feedback and made changes as necessary to improve customer service.
Implemented new technologies into the business model in order to streamline processes.
Developed pricing models based on cost analysis of materials, labor, overhead expenses.
Managed daily operations such as sales transactions, accounts receivable, payable, shipping, receiving functions.
Built strong vendor relationships by providing exceptional customer service throughout the supply chain process.
Designed employee training programs that focused on efficiency improvement initiatives.
Made financial and logistics decisions in best interest of company.
Took care of escalated customer concerns to increase satisfaction.
Consulted with potential clients to determine how company could best meet needs.
Developed estimates for clients home repair services based on in-depth knowledge of labor and material expenses.
Interviewed, trained and supervised employees.
Promoted business on social media platforms to maximize brand identity and generate revenue.
Set pricing structures according to market analytics and emerging trends.